The musings of a health psychology writer and researcher

Nudge Theory

I was on Three Counties radio today with Ronnie Barbour of ‘The One Show’ (TOOSH). The topic was related to a BBC article that came out today – ‘Nudge not enough to change lifestyle.’ Here are some of the points I discussed:

What is Nudge Theory?

Nudge Theory originated in the US through the work of Professor Richard Thaler.

It was introduced to Britain in 2008 when David Cameron expressed an interest in the theory.

This led to the development of Number 10’s Behavioural Insight Team – ‘The Nudge Unit.’

Nudge Theory is about encouraging, or nudging, people to make healthier lifestyle choices without being ‘nannied’ and without losing freedom of choice.

Rather than trying to overtly ‘change’ people’s behaviour, the idea is to subtly direct people down a particular path by altering their environment.

At the core of the nudges concept is making healthier options more feasible, accessible, and appealing.

Why do we need Nudge Theory?

Humans have deeply ingrained unhealthy lifestyle habits that are not easy to change.

We have 2 ways of thinking – an automatic system and a reflective system.

Reflective thinking – requires effort, control, and awareness.

To overcome habit-induced barriers to change, ‘reflective’ thinking is needed (e.g. a conscious effort to do something different, such as eat an extra piece of fruit a day).

How can nudges be used?

iNcentives (i.e. as opposed to punishment or penalties, e.g. healthy food vouchers). We are loss averse – losing something makes you twice as miserable as gaining something that makes you happy. Thus, rewards work better.

Understand mappings (e.g. help people map their options in order to make decisions that benefit them).

Defaults (e.g. design health interventions that people opt out of rather than opt in to).

Give feedback (e.g. inform people when they are doing well or how they might do better – again, this is based on rewards).

Expect error (e.g. offer relapse prevention strategies).

Structure complex choices (e.g. facilitate weighing up the pros and cons of different options).

Examples of a nudge theory as applied to health?

Fruit at eye level and chocolate at a lower level – increases cognitive effort – the “cost” of choosing chocolate is increased.

Altering the ‘default setting’ – people get salad with their meal unless they specifically ask not to have salad with their meal.

Opting out rather than in to organ donation.

Are nudges effective?

Simply asking the question, ‘do you want to quit smoking?’ has been found to encourage behaviour change.

Nudges are about long-term benefits – we won’t necessarily see them now.

Stages of change – a nudge can push us along those stages of considering or acting on change.

Fun examples of nudge theory in action:

Amsterdam airport – a motif made to look like a fly was embossed in the mend’s urinals – an 80% reduction in ‘spills’ and overall greater cleanliness in the toilets.

Sweden – refer to nudge theory as “fun theory” – bottle bank fruit machine – game where people were invited to try and insert different colour glass into the correct hole – lights and sounds when they got it right.

Finally, it is important to notice that Thaler and Sunstein do not argue for opt-out system for registering for organdonation but for “prompted choice”. In fact, I tend to see opt-out as an ethically problematic solution, cf: